This year our class is taking on the challenge of trying to solve some of the issues that have plagued our globe over the past twenty years. This page is designed to record our journey along the way as well as serve as a dumping ground for any information that we may come across as we begin and continue to research a possible solution.
Global Issue #1: Solving the Global Issue of Malaria and How to Best Control the Disease
The following document will serve as a template for you to follow as you go along and begin organizing you information.
Solving the Issues of the World…One Friday at a Time
Group Names: Alex Dulisse Max Abramson
Global Issue #1: Malaria
Background of Issue: (who?, what?, where?, when?, why?) Group Names: ALeX Duilisse, and Max Abramson
Who:
Where: People of all ages affected by malaria in places such as Africa, Central America, South America, many tropical islands, and many other places around the world.Malaria causes 2414 deaths a day on average, someone dies from malaria every thirteen seconds, Malaria kills a child somewhere in the world every 30 seconds, It infects 350-500 million people each year, and kills 1 million
What: People get malaria from a parasite called Plasmodium which one gets from being bitten by a mosquito, however out of the five types of Plasmodium the leader in deaths by a large margin is Plasmodium Falciparum once the parasite gets in the bloodstream, they reproduce rapidly. Different types of the parasite give different types of malaria.
Where: This is a list of Malaria affected countries in alphabetical order from A-Z, as you can see it is a very large showing how large of an impact malaria has.
A
Afghanistan
Algeria
Angola
Argentina
Azerbaijan
B
Bangladesh
Belize
Benin
Bhutan
Bolivia (Plurinational State of)
Botswana
Brazil
Burkina Faso
Burundi
C
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
D
Democratic People's Republic of Korea
Democratic Republic of the Congo
Djibouti
Dominican Republic
E
Ecuador
El Salvador
Equatorial Guinea
Eritrea
Ethiopia
F
French Guiana
G
Gabon
Gambia
Georgia
Ghana
Guatemala
Guinea
Guinea-Bissau
Guyana
H
Haiti
Honduras
I
India
Indonesia
Iran (Islamic Republic of)
Iraq
K
Kenya
Kyrgyzstan
L
Lao People's Democratic Republic
Liberia
M
Madagascar
Malawi
Malaysia
Mali
Mauritania
Mexico
Mozambique
Myanmar
N
Namibia
Nepal
Nicaragua
Niger
Nigeria
P
Pakistan
Panama
Papua New Guinea
Paraguay
Peru
Philippines
R
Republic of Korea
Rwanda
S
Sao Tome and Principe
Saudi Arabia
Senegal
Sierra Leone
Solomon Islands
Somalia
South Africa
Sri Lanka
Sudan North (low transmission)
Sudan South (high transmission)
Suriname
Swaziland
T
Tajikistan
Thailand
Timor-Leste
Togo
Turkey
U
Uganda
United Republic of Tanzania (Mainland)
United Republic of Tanzania (Zanzibar)
Uzbekistan
V
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Y
Yemen
Z
Zambia
Zimbabwe
Malaria Deaths
Malaria Info
Why: Female mosquitoes need to get a blood meal for their eggs when they hatch. But when a person is bitten, there is a chance that the person will get the malaria parasite. If the person already has the parasite, they might give it to the mosquito which they can then spread to others.
Costs: human and/or financial cost? CDC (Center for Disease Control) Quote from their website, “Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2010, the WHO estimated 216 million cases of malaria occurred worldwide and 655,000 people died, most (91%) in the African Region.” The estimated number of people infected, are probably just a fraction of the total amount of people that get malaria due to the fact that most people that live in Africa live in rural areas away from places where they can be treated and/or documented. it was estimated in 2012 that Malaria costs Africa an estimated 12 Billion USD every year in costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The current U.S. cost for malaria is U.S. malaria funding goes through two main streams - the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President's Malaria Initiative - and some additional money is channeled through other bilateral programs. The Global Fund is a unique public-private partnership that allots approximately 25% of its funds towards fighting malaria. The President's Malaria Initiative (PMI) was announced on June 30, 2005 by President Bush as a new U.S. commitment to spend an additional $1.2 billion between 2005 and 2010 and cut malaria related deaths by 50% in 15 focus countries in Africa. The Bill and Melinda Gates Foundation is partnering with national malaria control programs, international organizations and the private sector with a goal of providing prevention and treatment for 175 million of the most vulnerable people (children under the age of five, pregnant women and people living with HIV/AIDS) in its 15 focus nations by 2010. PMI is providing anti-malarial drugs, insecticide-treated bed nets, treatment for pregnant women and indoor mosquito spraying. The first phase of the program was launched in early 2006 in Uganda, Angola and Tanzania. PMI is now operating in a total of 15 focus countries, all of which are in Africa.By 2008, PMI activities had already reached over 32 million people in the focus countries.
U.S. Funding for Malaria
In total, the U.S. directs money to the fight against malaria in three ways:
1.The Global Fund to Fight AIDS, TB and Malaria-U.S. contributions to the Global Fund have increased in recent years, and as a result, overall U.S. funding for malaria has increased as well. The Global Fund has allotted approximately 25% of the funds it has disbursed since its inception towards fighting malaria. The Global Fund is now the world's largest external financing source for malaria programs, providing three-quarters of all international financing.
2.President's Malaria Initiative (PMI)-The PMI is a bilateral, interagency initiative that is scaling up existing bilateral efforts by focusing on 15 countries. It is led by the U.S. Agency for International Development (USAID) in partnership with the Centers for Disease Control (CDC), Department of Health and Human Services, and the Department of State.
3.Other bilateral programs-Funding for bilateral malaria efforts outside of The Bill and Melinda Gates Foundation are also programmed through USAID and CDC. In addition to the 15 focus countries, the U.S. will maintain efforts in Burundi, the Democratic Republic of Congo, Eritrea, Guinea, Nigeria and Sudan.
Symptoms
Anemia
Bloody stools
Chills
Coma
Convulsion
Fever
Headache
Jaundice
Muscle pain
Nausea
Sweating
Vomiting
Signs and tests
During a physical examination, the doctor may find an enlarged liver or enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.
A complete blood count (CBC) will identify anemia if it is present.
Treatment
Malaria, especially Falciparum malaria, is a medical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. However, chloroquine-resistant infections are common in some parts of the world. Possible treatments for chloroquine-resistant infections include:
The combination of quinidine or quinine plus doxycycline, tetracycline, or clindamycin
Atovaquone plus proguanil (Malarone)
Mefloquine or artesunate
The combination of pyrimethamine and sulfadoxine (Fansidar)
The choice of medication depends in part on where you were when you were infected. Medical care, including fluids through a vein (IV) and other medications and breathing (respiratory) support may be needed.
Expectations (prognosis)
The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications without extensive treatment. HIV/AIDS plays a large part in that people with HIV/AIDS are more at risk for more seroius complications as well as due to little or no immune system response may lead to cerebral malaria which is a much more serious form of malaria which has a low survival rate.
Complications
Brain infection (cerebritis)
Destruction of blood cells (hemolytic anemia)
kidney failure
Liver failure
meningitis
Respiratory failure from fluid in the lungs (pulmonary edema)
Rupture of the spleen leading to massive internal bleeding (hemorrhage)
Previous Efforts Put Into Place to Help Resolve Issue: There have been many attempts to eradicate malaria from certain places. in some cases it was sucessful such as in the U.S., but most eradication efforts have resulted in chloro quinine resistant mosquitoes. This is the case in many places in Africa, South Eastern Asia, and Central and South America. The chemicals involved in the treatment of Plasmodium Falciparum has changed over the years, but the most modern of these cures is Artemisinins discovered by Chinese scientists in 1970
Reasons why previous efforts to help resolve issue have failed:
Some cases have been sucessful however most have failed due mainly to the misquitoes developing a resistance to quinine and DDT. Also in most other cases stagnent water was left untouched leaving infected larvae alive. In many countris as well it would take a large sum of money to keep programs to erdicate Malaria running, In some countries with a heavy malaria burden, the disease may account for as much as 40% of public health expenditure, 30–50% of admissions to hospital, and up to 50% of outpatient visits.
this is a list of the currently available anti malarial drugs currertly available the best results come from extracts of the plant Artemisia annua, containing the compound artemisinin or semi-synthetic derivatives (a substance unrelated to quinine), offer over 90% efficacy rates, but their supply is not meeting demand.
Artemether- lumefantrine (Therapy only, commercial names Coartem and Riamet)
Atovaquone- proguanil, trade name Malarone (Therapy and prophylaxis)
Quinine (Therapy only)
Chloroquine (Therapy and prophylaxis; usefulness now reduced due to resistance)
Cotrifazid (Therapy and prophylaxis)
Doxycycline (Therapy and prophylaxis)
Mefloquine, trade name Lariam (Therapy and prophylaxis)
Primaquine (Therapy in P. vivax and P. ovale only; not for prophylaxis)
Proguanil (Prophylaxis only)
Sulfadoxine- pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women in endemic countries as "Intermittent Preventive Treatment" - IPT)
Hydroxychloroquine, trade name Plaquenil (Therapy and prophylaxis)
Areas of concern on reaching your desired solution to the global issue:
There are several vaccines in testing now, also there is other metheds such as quinine (not very effective due to the fact that misquitoes can develop immunity to it), draining mashland which was very useful in the eradication of malaira from the small country the Republic of Martitius
Outside Reasearch: YOUR PLAN OF ACTION! (for this section, you will need to provide the most detail as you lay a step-by-step plan on how your group will go about tackling this issue. It is important that you take a look at all the information you have researched and studied and use that information to develop a true, realistic and effective plan of action. The plan needs to include funding, people involved, time length of project, materials needed, etc…)
Malaria Prevention and Control
"Methods used to prevent the spread of disease, or to protect individuals in areas where malaria is endemic, include prophylactic drugs, mosquito eradication, and the prevention of mosquito bites. The continued existence of malaria in an area requires a combination of high human population density, high mosquito population density, and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will sooner or later disappear from that area, as happened in North America, Europe and much of Middle East. However, unless the parasite is eliminated from the whole world, it could become re-established if conditions revert to a combination that favors the parasite's reproduction. Many countries are seeing an increasing number of imported malaria cases due to extensive travel and migration. There is currently no vaccine that will prevent malaria, but this is an active field of research. .
Prophylactic drugs
Several drugs, most of which are also used for treatment of malaria, can be taken preventively. Generally, these drugs are taken daily or weekly, at a lower dose than would be used for treatment of a person who had actually contracted the disease. Use of prophylactic drugs is seldom practical for full-time residents of malaria-endemic areas, and their use is usually restricted to short-term visitors and travelers to malarial regions. This is due to the cost of purchasing the drugs, negative side effects from long-term use, and because some effective anti-malarial drugs are difficult to obtain outside of wealthy nations. Quinine was used starting in the seventeenth century as a prophylactic against malaria. The development of more effective alternatives such as quinacrine, chloroquine, and primaquine in the twentieth century reduced the reliance on quinine. Today, quinine is still used to treat chloroquine resistant Plasmodium falciparum, as well as severe and cerebral stages of malaria, but is not generally used for prophylaxis. The choice of which drug to use depends on which drugs the parasites in the area are resistant to, as well as side-effects and other considerations. People temporarily visiting malaria-endemic areas usually begin taking the drugs one to two weeks before arriving and must continue taking them for 4 weeks after leaving .
Indoor residual spraying
Indoor residual spraying (IRS) is the practice of spraying insecticides on the interior walls of homes in malaria affected areas. After feeding, many mosquito species rest on a nearby surface while digesting the bloodmeal, so if the walls of dwellings have been coated with insecticides, the resting mosquitos will be killed before they can bite another victim, transferring the malaria parasite.
A
The first and historically the most popular insecticide used for IRS is DDT. While it was initially used exclusively to combat malaria, its use quickly spread to agriculture. In time, pest-control, rather than disease-control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of resistant mosquitoes in many regions. If the use of DDT was limited agriculturally, DDT may be more effective now as a method of disease-control. The DDT resistance shown by Anopheles mosquitoes can be compared to antibiotic resistance shown by bacteria. The overuse of anti-bacterial soaps and antibiotics have led to antibiotic resistance in bacteria, similar to how overspraying of DDT on crops have led to DDT resistance in Anopheles mosquitoes. During the 1960s, awareness of the negative consequences of its indiscriminate use increased ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.Though DDT has never been banned for use in malaria control and there are several other insecticides suitable for IRS, some advocates have claimed that bans are responsible for tens of millions of deaths in tropical countries where DDT had once been effective in controlling malaria. Furthermore, most of the problems associated with DDT use stem specifically from its industrial-scale application in agriculture, rather than its use in public health.The World Health Organization (WHO) currently advises the use of 12 different insecticides in IRS operations. These include DDT and a series of alternative insecticides (such as the pyrethroidspermethrin and deltamethrin) to both, combat malaria in areas where mosquitoes are DDT-resistant, and to slow the evolution of resistance. This public health use of small amounts of DDT is permitted under the Stockholm Convention on Persistent Organic Pollutants (POPs), which prohibits the agricultural use of DDT. However, because of its legacy, many developed countries discourage DDT use even in small quantities.One problem with all forms of Indoor Residual Spraying is insecticide resistance via evolution of mosquitos.
Mosquito nets and bedclothes
Mosquito nets help keep mosquitoes away from people, and thus greatly reduce the infection and transmission of malaria. The nets are not a perfect barrier, so they are often treated with an insecticide designed to kill the mosquito before it has time to search for a way past the net.Insecticide-treated nets (ITN) are estimated to be twice as effective as untreated nets, and offer greater than 70% protection compared with no net. Although ITN are proven to be very effective against malaria, less than 2% of children in urban areas in Sub-Saharan Africa are protected by ITNs. Since the Anopheles mosquitoes feed at night, the preferred method is to hang a large "bed net" above the center of a bed such that it drapes down and covers the bed completely.The extensive distribution of mosquito nets impregnated with insecticide (often permethrin or deltamethrin) has shown to be an extremely effective method of malaria prevention, and also one of the most cost-effective methods of prevention in East Africa.For maximum effectiveness, the nets should be re-impregnated with insecticide every six months. New technologies like Olyset or DawaPlus allow for production of long-lasting insecticidal mosquito nets (LLINs), which release insecticide for approximately 5 years.ITNs have the advantage of protecting people sleeping under the net and simultaneously killing mosquitoes that contact the net. This has the effect of killing the most dangerous mosquitoes. Some protection is also provided to others, including people sleeping in the same room but not under the net.VaccinationVaccines for malaria are under development, with no completely effective vaccine yet available. Presently, there is a huge variety of vaccine candidates on the table.Pre-erythrocytic vaccines (vaccines that target the parasite before it reaches the blood), in particular vaccines based on circumsporozoite protein (CSP), make up the largest group of research for the malaria vaccine. Other vaccine candidates include: those that seek to induce immunity to the blood stages of the infection; those that seek to avoid more severe pathologies of malaria by preventing adherence of the parasite to blood venules and placenta; and transmission-blocking vaccines that would stop the development of the parasite in the mosquito right after the mosquito has taken a bloodmeal from an infected person. It is hoped that the sequencing of the P. falciparumgenome will provide targets for new drugs or vaccines.
Other methods
Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the East Africa by as much as 20%. Recognizing the disease in the early stages can also stop the disease from becoming a killer. Education can also inform people to cover over areas of stagnant, still water e.g. Water Tanks which are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is most put in practice in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas."E.A.C.H.A.
Global Issue #1: Solving the Global Issue of Malaria and How to Best Control the Disease
The following document will serve as a template for you to follow as you go along and begin organizing you information.
Solving the Issues of the World…One Friday at a Time
Group Names: Alex Dulisse Max Abramson
Global Issue #1: Malaria
Background of Issue: (who?, what?, where?, when?, why?)
Group Names: ALeX Duilisse, and Max Abramson
Who:
Where: People of all ages affected by malaria in places such as Africa, Central America, South America, many tropical islands, and many other places around the world.Malaria causes 2414 deaths a day on average, someone dies from malaria every thirteen seconds, Malaria kills a child somewhere in the world every 30 seconds, It infects 350-500 million people each year, and kills 1 million
What: People get malaria from a parasite called Plasmodium which one gets from being bitten by a mosquito, however out of the five types of Plasmodium the leader in deaths by a large margin is Plasmodium Falciparum once the parasite gets in the bloodstream, they reproduce rapidly. Different types of the parasite give different types of malaria.
Where: This is a list of Malaria affected countries in alphabetical order from A-Z, as you can see it is a very large showing how large of an impact malaria has.A
B
C
D
E
F
G
H
I
K
L
Liberia
M
N
P
R
S
T
U
V
Y
Z
Why: Female mosquitoes need to get a blood meal for their eggs when they hatch. But when a person is bitten, there is a chance that the person will get the malaria parasite. If the person already has the parasite, they might give it to the mosquito which they can then spread to others.
Costs: human and/or financial cost?CDC (Center for Disease Control) Quote from their website, “Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2010, the WHO estimated 216 million cases of malaria occurred worldwide and 655,000 people died, most (91%) in the African Region.” The estimated number of people infected, are probably just a fraction of the total amount of people that get malaria due to the fact that most people that live in Africa live in rural areas away from places where they can be treated and/or documented. it was estimated in 2012 that Malaria costs Africa an estimated 12 Billion USD every year in costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The current U.S. cost for malaria is U.S. malaria funding goes through two main streams - the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President's Malaria Initiative - and some additional money is channeled through other bilateral programs. The Global Fund is a unique public-private partnership that allots approximately 25% of its funds towards fighting malaria. The President's Malaria Initiative (PMI) was announced on June 30, 2005 by President Bush as a new U.S. commitment to spend an additional $1.2 billion between 2005 and 2010 and cut malaria related deaths by 50% in 15 focus countries in Africa. The Bill and Melinda Gates Foundation is partnering with national malaria control programs, international organizations and the private sector with a goal of providing prevention and treatment for 175 million of the most vulnerable people (children under the age of five, pregnant women and people living with HIV/AIDS) in its 15 focus nations by 2010. PMI is providing anti-malarial drugs, insecticide-treated bed nets, treatment for pregnant women and indoor mosquito spraying. The first phase of the program was launched in early 2006 in Uganda, Angola and Tanzania. PMI is now operating in a total of 15 focus countries, all of which are in Africa.By 2008, PMI activities had already reached over 32 million people in the focus countries.
U.S. Funding for Malaria
In total, the U.S. directs money to the fight against malaria in three ways:
1. The Global Fund to Fight AIDS, TB and Malaria-U.S. contributions to the Global Fund have increased in recent years, and as a result, overall U.S. funding for malaria has increased as well. The Global Fund has allotted approximately 25% of the funds it has disbursed since its inception towards fighting malaria. The Global Fund is now the world's largest external financing source for malaria programs, providing three-quarters of all international financing.
2. President's Malaria Initiative (PMI)-The PMI is a bilateral, interagency initiative that is scaling up existing bilateral efforts by focusing on 15 countries. It is led by the U.S. Agency for International Development (USAID) in partnership with the Centers for Disease Control (CDC), Department of Health and Human Services, and the Department of State.
3. Other bilateral programs-Funding for bilateral malaria efforts outside of The Bill and Melinda Gates Foundation are also programmed through USAID and CDC. In addition to the 15 focus countries, the U.S. will maintain efforts in Burundi, the Democratic Republic of Congo, Eritrea, Guinea, Nigeria and Sudan.
Symptoms
Signs and tests
During a physical examination, the doctor may find an enlarged liver or enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.
A complete blood count (CBC) will identify anemia if it is present.
Treatment
Malaria, especially Falciparum malaria, is a medical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. However, chloroquine-resistant infections are common in some parts of the world.Possible treatments for chloroquine-resistant infections include:
- The combination of quinidine or quinine plus doxycycline, tetracycline, or clindamycin
- Atovaquone plus proguanil (Malarone)
- Mefloquine or artesunate
- The combination of pyrimethamine and sulfadoxine (Fansidar)
The choice of medication depends in part on where you were when you were infected.Medical care, including fluids through a vein (IV) and other medications and breathing (respiratory) support may be needed.
Expectations (prognosis)
The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications without extensive treatment. HIV/AIDS plays a large part in that people with HIV/AIDS are more at risk for more seroius complications as well as due to little or no immune system response may lead to cerebral malaria which is a much more serious form of malaria which has a low survival rate.Complications
Previous Efforts Put Into Place to Help Resolve Issue:
There have been many attempts to eradicate malaria from certain places. in some cases it was sucessful such as in the U.S., but most eradication efforts have resulted in chloro quinine resistant mosquitoes. This is the case in many places in Africa, South Eastern Asia, and Central and South America. The chemicals involved in the treatment of Plasmodium Falciparum has changed over the years, but the most modern of these cures is Artemisinins discovered by Chinese scientists in 1970
Reasons why previous efforts to help resolve issue have failed:
Some cases have been sucessful however most have failed due mainly to the misquitoes developing a resistance to quinine and DDT. Also in most other cases stagnent water was left untouched leaving infected larvae alive. In many countris as well it would take a large sum of money to keep programs to erdicate Malaria running, In some countries with a heavy malaria burden, the disease may account for as much as 40% of public health expenditure, 30–50% of admissions to hospital, and up to 50% of outpatient visits.
this is a list of the currently available anti malarial drugs currertly available the best results come from extracts of the plant Artemisia annua, containing the compound artemisinin or semi-synthetic derivatives (a substance unrelated to quinine), offer over 90% efficacy rates, but their supply is not meeting demand.
Areas of concern on reaching your desired solution to the global issue:
There are several vaccines in testing now, also there is other metheds such as quinine (not very effective due to the fact that misquitoes can develop immunity to it), draining mashland which was very useful in the eradication of malaira from the small country the Republic of Martitius
Sources:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646/
(U.S. National Library of Medicine)
http://www.cdc.gov/MALARIA/
(Center for Disease Control and Prevention)
http://www.who.int/topics/malaria/en/
(World Health Organization)
http://blog.ted.com/2010/05/11/zap_invention_t/
(TED talks)
http://www.ted.com/talks/bill_gates_unplugged.html
(TED talks)
http://www.gatesfoundation.org/topics/Pages/malaria.aspx
(Bill and Melinda Gates Foundation)
http://one.org/c/us/issuebrief/748/#_ftn1
(ONE Organization)
http://www.unicef.org/health/index_malaria.html
(UNICEF United Nations International Children's Emergency Fund)
http://www.eac.int/health/index.php?option=com_content&view=article&id=95%3Aclassification-system&catid=15%3Adiseases&Itemid=32
(East African Community Health Association)
Outside Reasearch:
YOUR PLAN OF ACTION! (for this section, you will need to provide the most detail as you lay a step-by-step plan on how your group will go about tackling this issue. It is important that you take a look at all the information you have researched and studied and use that information to develop a true, realistic and effective plan of action. The plan needs to include funding, people involved, time length of project, materials needed, etc…)
The continued existence of malaria in an area requires a combination of high human population density, high mosquito population density, and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will sooner or later disappear from that area, as happened in North America, Europe and much of Middle East.
However, unless the parasite is eliminated from the whole world, it could become re-established if conditions revert to a combination that favors the parasite's reproduction. Many countries are seeing an increasing number of imported malaria cases due to extensive travel and migration.
There is currently no vaccine that will prevent malaria, but this is an active field of research.
.
Prophylactic drugs
Several drugs, most of which are also used for treatment of malaria, can be taken preventively. Generally, these drugs are taken daily or weekly, at a lower dose than would be used for treatment of a person who had actually contracted the disease. Use of prophylactic drugs is seldom practical for full-time residents of malaria-endemic areas, and their use is usually restricted to short-term visitors and travelers to malarial regions. This is due to the cost of purchasing the drugs, negative side effects from long-term use, and because some effective anti-malarial drugs are difficult to obtain outside of wealthy nations.Quinine was used starting in the seventeenth century as a prophylactic against malaria. The development of more effective alternatives such as quinacrine, chloroquine, and primaquine in the twentieth century reduced the reliance on quinine. Today, quinine is still used to treat chloroquine resistant Plasmodium falciparum, as well as severe and cerebral stages of malaria, but is not generally used for prophylaxis.
The choice of which drug to use depends on which drugs the parasites in the area are resistant to, as well as side-effects and other considerations. People temporarily visiting malaria-endemic areas usually begin taking the drugs one to two weeks before arriving and must continue taking them for 4 weeks after leaving .
Indoor residual spraying
Indoor residual spraying (IRS) is the practice of spraying insecticides on the interior walls of homes in malaria affected areas. After feeding, many mosquito species rest on a nearby surface while digesting the bloodmeal, so if the walls of dwellings have been coated with insecticides, the resting mosquitos will be killed before they can bite another victim, transferring the malaria parasite.A
The first and historically the most popular insecticide used for IRS is DDT. While it was initially used exclusively to combat malaria, its use quickly spread to agriculture. In time, pest-control, rather than disease-control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of resistant mosquitoes in many regions. If the use of DDT was limited agriculturally, DDT may be more effective now as a method of disease-control. The DDT resistance shown by Anopheles mosquitoes can be compared to antibiotic resistance shown by bacteria. The overuse of anti-bacterial soaps and antibiotics have led to antibiotic resistance in bacteria, similar to how overspraying of DDT on crops have led to DDT resistance in Anopheles mosquitoes. During the 1960s, awareness of the negative consequences of its indiscriminate use increased ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.Though DDT has never been banned for use in malaria control and there are several other insecticides suitable for IRS, some advocates have claimed that bans are responsible for tens of millions of deaths in tropical countries where DDT had once been effective in controlling malaria. Furthermore, most of the problems associated with DDT use stem specifically from its industrial-scale application in agriculture, rather than its use in public health.The World Health Organization (WHO) currently advises the use of 12 different insecticides in IRS operations. These include DDT and a series of alternative insecticides (such as the pyrethroids permethrin and deltamethrin) to both, combat malaria in areas where mosquitoes are DDT-resistant, and to slow the evolution of resistance. This public health use of small amounts of DDT is permitted under the Stockholm Convention on Persistent Organic Pollutants (POPs), which prohibits the agricultural use of DDT. However, because of its legacy, many developed countries discourage DDT use even in small quantities.One problem with all forms of Indoor Residual Spraying is insecticide resistance via evolution of mosquitos.
Mosquito nets and bedclothes
Mosquito nets help keep mosquitoes away from people, and thus greatly reduce the infection and transmission of malaria. The nets are not a perfect barrier, so they are often treated with an insecticide designed to kill the mosquito before it has time to search for a way past the net.Insecticide-treated nets (ITN) are estimated to be twice as effective as untreated nets, and offer greater than 70% protection compared with no net. Although ITN are proven to be very effective against malaria, less than 2% of children in urban areas in Sub-Saharan Africa are protected by ITNs. Since the Anopheles mosquitoes feed at night, the preferred method is to hang a large "bed net" above the center of a bed such that it drapes down and covers the bed completely.The extensive distribution of mosquito nets impregnated with insecticide (often permethrin or deltamethrin) has shown to be an extremely effective method of malaria prevention, and also one of the most cost-effective methods of prevention in East Africa.For maximum effectiveness, the nets should be re-impregnated with insecticide every six months. New technologies like Olyset or DawaPlus allow for production of long-lasting insecticidal mosquito nets (LLINs), which release insecticide for approximately 5 years.ITNs have the advantage of protecting people sleeping under the net and simultaneously killing mosquitoes that contact the net. This has the effect of killing the most dangerous mosquitoes. Some protection is also provided to others, including people sleeping in the same room but not under the net.VaccinationVaccines for malaria are under development, with no completely effective vaccine yet available. Presently, there is a huge variety of vaccine candidates on the table.Pre-erythrocytic vaccines (vaccines that target the parasite before it reaches the blood), in particular vaccines based on circumsporozoite protein (CSP), make up the largest group of research for the malaria vaccine. Other vaccine candidates include: those that seek to induce immunity to the blood stages of the infection; those that seek to avoid more severe pathologies of malaria by preventing adherence of the parasite to blood venules and placenta; and transmission-blocking vaccines that would stop the development of the parasite in the mosquito right after the mosquito has taken a bloodmeal from an infected person. It is hoped that the sequencing of the P. falciparum genome will provide targets for new drugs or vaccines.Other methods
Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the East Africa by as much as 20%. Recognizing the disease in the early stages can also stop the disease from becoming a killer. Education can also inform people to cover over areas of stagnant, still water e.g. Water Tanks which are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is most put in practice in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas."E.A.C.H.A.